How to Start an NEMT Business in Seattle: A "Bambi Knows Best" State-By-State Series Before diving into the green state of Washington, specifically in its NEMT market (to make that green!), it’s essential to conduct thorough market research and gain a clear and comprehensive understanding of the state's healthcare system and transportation network. Washington’s varied landscape — from vibrant cities like Seattle and Spokane to rural areas and coastal communities — creates a broad and nuanced demand for NEMT services. Here’s how to navigate this diverse market:
1 | Identify Existing NEMT Providers in Washington
Understanding the existing NEMT services across Washington State is important for spotting opportunities and managing competition. The Washington State Health Care Authority (HCA) oversees Medicaid-funded NEMT services, ensuring compliance with both federal and state regulations. Key providers include both large transportation companies and local operators:
Hopelink Around the Sound King County Metro Access Public Transportation Providers : Regional transit systems such as Sound Transit and Pierce Transit provide NEMT options in their respective regions.Uber Health Consult local directories and online resources to identify additional NEMT providers in key cities like Spokane, Tacoma, Olympia or wherever you feel the pull to start your biz.
2 | Assess the Demand for NEMT Services
Evaluate the demand for NEMT services by focusing on major healthcare facilities and community needs across Washington:
Adult Day Care Centers : there are approximately 250 to 300 Adult Day Care Centers (ADCs). These centers offer various services to support the elderly and individuals with disabilities, including social activities, health monitoring, and personal care. For the most current and accurate information, you might want to consult the Washington State Department of Social and Health Services or local aging and adult services organizations.Dialysis Clinics : Many clinics are peppered across the state, operated by major healthcare providers such as Fresenius Kidney Care and DaVita Dialysis.Physical Therapy Centers : There are many of these PT centers available throughout the state. The Washington State Physical Therapy Association can provide updated information.Hospitals : As of recent data, there are around 100 to 120 hospitals across the state. Major facilities include the University of Washington Medical Center, Harborview Medical Center , and Swedish Medical Center .Nursing Homes and Assisted Living : There are approximately 230 licensed nursing homes. For the most current and precise information, checking with the Washington State Department of Social and Health Services (DSHS) or other state regulatory agencies is recommended.Outpatient Care Centers : Essential for the state's healthcare network. Contact local providers and the hospitals above for details on their partnerships and NEMT needs.3 | Decide on a Target Market
Identify your target demographic based on the demand from various healthcare facilities. Whether you focus on seniors, individuals with disabilities, or a wider patient base, tailoring your services to meet these needs will enhance your business effectiveness and marketing efforts.
4 | Choose Specific NEMT Services
Determine which NEMT services are in high demand in Washington. Specializing in areas such as senior transportation, medical appointments or specialized care facilities will help you address local needs and establish a niche in the market.
5 | Understand Medicaid Delivery Models in Washington
Washington's Medicaid program, known as Apple Health , primarily relies on managed care organizations (MCOs) to deliver most healthcare services, including NEMT. The Washington State Health Care Authority (HCA) oversees Medicaid and contracts with MCOs to manage NEMT services.
Integral to this system is the state's regional broker system, established in 1984 and the oldest of its kind in the nation. Washington employs six local, community-based brokers to coordinate transportation across 13 medical regions. These brokers — chosen through a competitive process — include local planning agencies, councils on aging, various human service organizations, and community transportation providers. They handle trip scheduling and provider payments, aiming to control costs, enhance service quality and ensure reliable access to care for all Medicaid recipients.
The state attributes significant improvements in cost control, service quality and safety to this brokerage system. Currently, brokers are reimbursed for actual service costs plus an average administrative fee of $3.64 per managed trip. Performance incentives, focusing on call center efficiency and cost-effectiveness, have been in place since 2011. Notably, nearly one-third of trips are provided via fixed-route transit. Washington’s diverse healthcare landscape and blend of urban and rural areas contribute unique aspects to its NEMT model.
Here’s a quick overview:
NEMT Model : Regional Brokers with support Managed Care Organizations (i.e. MCOs are still a part of the overall Medicaid managed care framework. They work in conjunction with regional brokers to ensure that Medicaid recipients receive necessary transportation services).Operating Authority : 1902(a)(70) State Plan AmendmentNEMT Expense Classification : Medical ExpensePoverty Rate : Approximately 12% live below the poverty lineUrban Population : About 75% live in urbanized areasEstimated Annual NEMT Expense : $70.4 MillionEstimated Number of Annual NEMT Trips : 2,828,910Public Transportation: 28%6 | Getting Paid
Washington Medicaid compensates transportation providers primarily through managed care organizations (MCOs). Here’s how payment methods generally work:
Managed Care Organizations (MCOs) : Providers contract with MCOs for coordination and payment of NEMT services.Fee-for-Service (FFS) : In some instances, providers may submit claims directly to Medicaid for reimbursement.Ensure compliance with Medicaid billing guidelines when submitting claims. For specific details, consult the Washington State Health Care Authority (HCA) or the designated MCOs.
Prepare to navigate Washington's NEMT landscape with precision and insight. Stay tuned for Part 2 , where we’ll guide you through developing a business plan tailored to Washington’s unique regulations and market conditions. Continue with us, or jump ahead in the TOC to explore more in our series to pave your path to success!
Comments
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Suspendisse varius enim in eros elementum tristique. Duis cursus, mi quis viverra ornare, eros dolor interdum nulla, ut commodo diam libero vitae erat. Aenean faucibus nibh et justo cursus id rutrum lorem imperdiet. Nunc ut sem vitae risus tristique posuere.